Biomedical subjects

C R Harman

Publications and source records attributed to C R Harman.

85 records · Page 5Linked to original sources

PubMed1984

Fetal biophysical profile score and the nonstress test: a comparative trial.

In this prospective blind study, 735 patients with high-risk pregnancies referred for antepartum testing of fetal well-being were randomly assigned to either a fetal biophysical profile scoring (375 patients) or a nonstress testing scheme (360 patients). Management was based on the results of antepartum tests, but the method of testing used was not disclosed. Fetal biophysical profile scoring resulted in a significantly higher positive predictive value in regards to low Apgar scores. Sensitivity, specificity, and accuracy, although higher with fetal biophysical profile scoring, did not demonstrate significant differences when compared with the nonstress test. The negative predictive value between the two methods was similar. All major anomalies were detected during ultrasound scanning, whereas none of these anomalies were detected by heart rate testing alone.

Apgar Score↗

PubMed1983

Antepartum chronic fetal vesicoamniotic shunts for obstructive uropathy: A report of two cases.

Two fetuses with obstructive uropathy characterized by striking oligohydramnios and dilatation of the urinary collecting system were identified by ultrasound and treated by percutaneous insertion of a long-term vesicoamniotic silicone rubber shunt. Both fetuses were less than 16 weeks' gestation at diagnosis and less than 18 weeks at treatment. One fetus was delivered at 35 weeks and is alive and well; the other died early in the neonatal period at 31 weeks with pulmonary hypoplasia.

Adult↗

PubMed1983

Severe Rh disease--poor outcome is not inevitable.

Most centers report only moderate success in the intrauterine treatment of severe Rh-isoimmune hemolytic disease. For the hydropic fetus, the prognosis is poor. Innovations in the assessment, treatment, and follow-up of the severely affected fetus have yielded more encouraging results. Among the 24 fetuses receiving a refined management plan, instituted in June, 1980, survival rates were 100% in the nonhydropic fetus and 75% in the hydropic fetus. Improved fetal evaluation by means of extensive real-time ultrasonography allows more exact assessment of stage of disease, safer performance of intrauterine transfusion, and a direct picture of the fetal response to treatment. The intrauterine transfusion procedure differs in many aspects from those used in other centers and is notable mostly because of the absence of traumatic fetal death since the present program began. This improvement and the absence of neonatal death have resulted in 92% survival rate among the fetuses transfused. The success of this integrated team approach suggests revision of the pessimism toward the fetus with severe Rh disease.

Blood Transfusion, Intrauterine↗

PubMed1983

Intrauterine transfusion: kinetics of absorption of donor cells in fetal lambs.

The absorption of red cells from the peritoneal cavity of fetal lambs was studied in 29 pregnant ewes at approximately 120 days' gestation. Onset of absorption was early, absorption was rapid, and virtually complete absorption was shown in 96% of the fetuses by 92 hours after intrauterine transfusion. The mean time to complete 99% absorption was 75.8 hours, about half the time supposed for human fetuses. The rate of absorption and the maximum level of donor cells in the fetal circulation are both directly related to the transfusion volume. The time required to complete absorption does not vary with the volume transfused: The more blood given at intrauterine transfusion, the faster the fetus absorbs it. This study suggests that absorption in the fetus following intrauterine transfusion is very efficient, and may be faster than previously thought.

Absorption↗

PubMed1982

The correlation of ultrasonic placental grading and fetal pulmonary maturation in five hundred sixty-three pregnancies.

In a previous study, it was suggested that the presence of a grade III placenta correlates 100% with a mature lecithin/sphingomyelin (L/S) ratio and may replace amniocentesis in confirming fetal lung maturity. In this study that hypothesis was tested in 563 pregnancies. All patients underwent amniocentesis and simultaneously had placental grading. The correlations of placental grade with an L/S ration greater than or equal to 2 were: grade 0, 17%; grade I, 68%; grade II, 91%. The correlations of placental grade with the presence of phosphatidylglycerol (PG) were: grade 0, 17; grade 1, 41%; grade II, 79%; grade II, 75%. The false positive rates associated with grade III placenta were, therefore, 7% for mature L/S ratio and 25% for PG present: when combined with a biparietal diameter greater than or equal to 9.0 cm, a grade III placenta incorrectly predicted lung maturity in 8.5%. We conclude that placental grading is not accurate enough to replace amniocentesis as the standard test of fetal pulmonary maturity.

Amniocentesis↗

PubMed1981

Factors influencing morbidity in termination of pregnancy.

This study analyzes the morbidity of therapeutic abortion and identifies predisposing factors. A retrospective case evaluation of 2,105 pregnancy terminations was performed. Major complications occurred in 5% of those undergoing curettage procedures, 41% of women undergoing prostaglandin amnioinfusion, and 17% of those who had hysterotomy as a method of abortion. Age, parity, and history of previous pregnancy termination, had little effect on morbidity. Surgical/technical factors and reliance on amnioinfusion and hysterotomy as procedures of choice for pregnancy termination contributed significantly to the high morbidity rates. This contribution, however, was overshadowed by the influence of patient delay, physician delay, and limited abortion facilities, resulting in 35.4% of pregnancy terminations being performed in the midtrimester. Improvements in abortion technique may lower the incidence of complications, but the need for more appropriate facilities is emphasized.

Abortion, Induced↗

PubMedDate not supplied

Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion.

Isolated limb perfusion (ILP) with cytotoxic agents is an effective but complex procedure. Isolated limb infusion (ILI) has been developed as a simpler alternative. Catheters are inserted percutaneously into the axial artery and vein of the affected limb and a pneumatic tourniquet is inflated proximally. Cytotoxic agents are then infused through the arterial catheter and circulated with a syringe for 15 to 20 minutes. Progressive hypoxia occurs, but normothermia is maintained. To date, 175 ILIs have been performed: 164 for melanoma and 11 for other tumours. Results obtained are similar to those obtained by conventional ILP. Morbidity is low and treatment of frail and elderly patients who would not tolerate ILP is possible. An elective double ILI protocol can be used to obtain the additional benefits of fractionated chemotherapy. The possibility of increasing ILI response rates by using other drugs and drug combinations and by multiple fractionated dosing is being investigated.

Aged↗

PubMedDate not supplied

Epitrochlear lymph nodes as a site of melanoma metastasis.

BACKGROUND: The incidence of epitrochlear lymph node metastasis for patients with melanomas on the hand or forearm is disputed, and management guidelines for these nodes are unclear. METHODS: The records of 13,139 consecutive melanoma patients were reviewed to document the incidence of metastatic disease in epitrochlear nodes. The frequency of direct lymphatic drainage to epitrochlear nodes was determined for 109 patients with melanomas of the distal upper limb who had undergone preoperative lymphoscintigraphy. RESULTS: Nine of 801 patients (1.1%) with upper limb primary melanomas developed metastatic disease in an epitrochlear node, and one other patient with an occult primary tumor did so. Six of these ten patients underwent elective axillary node dissection at the time of surgery for epitrochlear node disease, and three were found to have metastatic disease in an axillary node. Epitrochlear node metastasis occurred in only two of 83 (2.4%) patients with upper extremity melanoma who underwent therapeutic axillary dissection. Of the 109 patients who underwent lymphoscintigraphy, four (3.7%) demonstrated lymphatic drainage to an epitrochlear node. CONCLUSIONS: Epitrochlear nodal involvement from melanoma of the distal upper extremity is rare, and routine epitrochlear node clearance at the time of either elective or therapeutic axillary dissection for upper extremity melanoma is not indicated. However, it is desirable to perform an axillary dissection whenever surgery for metastatic disease in an epitrochlear node is performed.

Adult↗

PubMedDate not supplied

Maximum possible impact of tocolytics in preventing preterm birth: a retrospective assessment.

Although tocolytic drugs are widely used to try to stop preterm labor, their actual contribution to preventing preterm deliveries is unknown. Since tocolytic drugs are not used at the University of Manitoba, it was possible to estimate the proportion of preterm deliveries that might have been eligible for tocolytic drug therapy. Of 364 consecutive preterm deliveries between 24 and 35 weeks, only 9% would have been eligible for, let alone prevented by, tocolytic drug therapy, and even a smaller percentage of babies would actually have benefitted from their use. The use of tocolytic drugs can, at best, benefit only a very small percentage of babies born preterm. Whether the risks of treatment justify this small benefit is arguable.

Female↗

PubMedDate not supplied

Successful intrauterine management of severe feto-fetal transfusion in a monochorionic triplet pregnancy using bipolar umbilical cord coagulation.

Triplet-to-triplet transfusion is a rare clinical complication of monochorionic pregnancies. We present such a case in a monochorionic triamniotic triplet gestation. After a single fetal demise an ongoing twin-to-twin transfusion continued in the surviving triplets. The donor triplet had ultrasound evidence of secondary structural brain damage. The pregnancy was successfully managed with bipolar umbilical cord coagulation of the donor triplet and spontaneous vaginal delivery of the recipient triplet. The case highlights the clinical spectrum and diagnostic and management options that present themselves in these high-risk pregnancies.

Adult↗

PubMedDate not supplied

Intrauterine thoracentesis of fetal cystic lung malformations.

Fetal pulmonary malformations comprise a rare but often lethal group of congenital anomalies. Until recently, diagnosis and therapy were directed postnatally and therefore some cases of fetal compromise were inevitably missed. We present 2 cases in which intermittent thoracentesis of fetal cystic lung malformations resulted in a successful outcome. Intrauterine thoracentesis should be considered in the second and third trimester of pregnancy in cases which demonstrate early fetal compromise.

Adult↗

PubMedDate not supplied

Complete resolution of CMV-associated acute hydramnios by single large volume reduction amniocentesis and maternal indomethacin. A case report.

Acute hydramnios is a rare complication of pregnancy, usually of idiopathic etiology and associated with a very poor perinatal prognosis. In this single case report, acute hydramnios at 21 weeks' gestation, associated with fetal CMV infection, was treated by a single large volume reduction amniocentesis combined with maternal indomethacin therapy and result in delivery of a near term survivor.

Adult↗

PubMedDate not supplied

MSAFP levels in aboriginal Canadian women.

Maternal serum alpha-fetoprotein (MSAFP) levels in 529 non-diabetic aboriginal Canadian women were compared with levels in 13,285 non-diabetic non-aboriginal women. A woman was considered to be aboriginal if she was listed on the Indian Register of Canada. After controlling for the gestational age on the date at which the sample was drawn and maternal weight, MSAFP levels appeared to be approximately 4 to 5% higher in aboriginal women. The possible implications of this finding on an MSAFP screening program are discussed.

Adult↗